Metzitzah b’peh (MBP)is a source of controversy within the Orthodox community, with more modern elements rejecting the ancient practice.

A conflict between ultra-Orthodox Jews and city health officials in New York over an ancient and custom accompanying circumcision, is largely symptomatic of an ideological rift that has split the observant Jewish community for over a century and defining the carious factions of contemporary orthodoxy’s approach towards modernity.

The practice, known as metzitzah b’peh (MBP) in Hebrew, is a source of controversy within the orthodox community, with more modern elements rejecting the ancient practice which in turn is embraced by the more conservative ultra-orthodox factions. Initially imposed as a safety measure by early Talmudic sages, researchers have linked it to the spread of Herpes.

According to the Centers for Disease Control and Prevention, infants who undergo MBP “had an estimated risk 3.4 times greater than the risk for HSV-1 or untyped HSV infection among male infants unlikely to have had direct orogenital suction.”

Proponents of the practice counter that MBP has been safely practiced for thousands of years without issue and argued, according to court records, that health authorities failed to “how even a statistical correlation between metzitzah b’peh and HSV infection.”

On Friday a Federal court marked a New York statute regulating MBP as potentially unconstitutional in a case hailed by the ultra-orthodox community as a “great victory.” The New York Health Department currently requires ritual circumcisers, or mohelim, to inform parents of the potential risks of metzitzah b’peh and to obtain written permission in order for the procedure to be carried out.

In response, a consortium of ultra-orthodox groups pursued litigation against the city, asserting that the informed consent rule was a violation of the first amendment in that it compelled speech in violation of the first amendment and that it was a violation of religious liberties.

Several prominent contemporary decisors of Jewish law such as Rabbi Dr. Moshe Tendler – son-in-law of late American ultra-orthodox leader Rabbi Moshe Feinstein - have called for the traditional method of suction to be shelved due to contemporary medical knowledge.

“The rule that’s above all rules in the Torah is that you cannot expose or accept a risk to health unless there is true justification for it,” Tendler told the New York Times in 2005.

Some orthodox opponents of traditional metzitzah utilize sterile glass or plastic pipets to prevent the transmission of germs. Such a practice was endorsed by 19th-century rabbi and father of ultra-orthodoxy Rabbi Moses Schreiber, also known as the Hatam Sofer, whose decision came out against a backdrop of widespread worry over infection.

The practice itself was instituted by the Misnaic sages in Israel over two thousand years ago as a health safeguard. As such, many in the modern orthodox community as well as those who follow a more rationalist approach to Judaism have argued for changes in the traditional practice of MBP in light of modern scientific findings regarding its efficacy.

Many early commentators such as Maimonides believed that the Talmud was not infallible in scientific matters that were unconnected to revealed divine law and the intellectual descendants of such thinkers have been proponents of modifying MBP.

Several prominent contemporary decisors of Jewish law such as Rabbi Dr. Moshe Tendler – son-in-law of late American ultra-orthodox leader Rabbi Moshe Feinstein - have called for the traditional method of suction to be shelved due to contemporary medical knowledge.

“The rule that’s above all rules in the Torah is that you cannot expose or accept a risk to health unless there is true justification for it,” Tendler told the New York Times in 2005.

Quoting an article from the journal Pediatrics that stated that “some orthodox rabbis have felt threatened by criticism of the old religious customs and strongly resist any change in the traditional custom of oral metzitza,” Slifkin argued that opposition to modifying the practice is rooted in the ideologies that formed the genesis of contemporary ultra-orthodoxy.

Aside from the rejection of any notion of fallibility on the part of the Talmud, students of the Hatam Sofer and their successors who fought against changes to MBP did so due to the fear that any change within orthodoxy would be exploited by their opponents within the rapidly growing reform movement. Such a policy frequently had the impact of elevating minor points of contention into pillars of orthodox faith and has been a defining trait of ultra-orthodoxy for over a century. Simply put, any change, no matter how minor, could be construed as an attack on Judaism.

The Hatam Sofer “himself saw no need to apply this policy to metzitzah b'peh, which in his time had not been challenged by the Reformers,” Slifkin wrote.

“He was able to evaluate it without any meta-halachic considerations, which is why he could make the simply and accurate observation that it was instituted as a medical precaution and thus could be freely abandoned if the doctors determined that it was harmful. But for disciple Maharam Schick, with whom metzitzah b'peh was something that the Reformers attempted to abolish as part of their general approach, it was necessary to apply his mentor's approach to this issue, and to elevate metzitzah b'peh to the level of halachah [from Sinai].”

While the issue of the regulation of MBP may seem a minor one, in the mindset of ultra-orthodox Judaism it is one of the defense of the entire edifice of traditional Judaism itself.